AB1222 POSITIVE DIAGNOSIS OF TUBERCULOUS SPONDYLODISCITIS: CT-GUIDED PERCUTANEOUS BIOPSY OF SPINAL LESIONS VERSUS CLINICAL, BIOLOGICAL AND IMAGING ARGUMENTS
Authors: M. Mrabet, S. Boussaid, S. B. Troudi, S. Rekik, S. Jemmali, S. Rahmouni, H. Ajlani, H. Sahli, M. Elleuch
Journal: Annals of the Rheumatic Diseases (2022)

Background Tuberculosis is still endemic in Tunisia. Although pulmonary localization is the most common, other localizations, including osteo-articular involvement, are increasingly diagnosed. Spinal or «Pott’s Disease» is the most common expression. A bundle of clinical, paraclinical and evolutionary arguments or a disco-vertebral biopsy puncture (DVBP) contribute to the positive diagnosis. Objectives Our aim was to assess the real contribution of DVBP compared to clinical-biological and imaging arguments for the diagnosis of tuberculous spondylodiscitis (SPDT). Methods We conduct a retrospective and descriptive study in a single rheumatology department. Data were collected from files of patients hospitalized in the past 20 years (2000-2020) who have been diagnosed with SPDT. Results Fifty-two cases of SPDT were collected (37F/15M). The mean age of the population was 55.21 years ± 17.79 [19-91]. Diagnosis SPDT was retained based on the results of the DVBP in 15 patients (28.8%); and it was strongly suspected in front of the presence of clinico-biological and imaging arguments in 37 patients (71.2%). Among the clinical arguments suggestive of SPDT were: progressive onset of symptoms in 47 patients (90.4%), segmental spinal stiffness in 37 patients (71.2%), spinal pain with general signs of tuberculosis such as impaired general condition, fever, night sweats and weight loss in 32 patients (61.5%). Lumbar spine involvement was the most common in tuberculous SPD (57.7%). A biological inflammatory syndrome has been objectified in 38 patients (73.1%). Imaging was contributive to positive diagnosis using standard X-rays, computed tomography and magnetic resonance imaging (MRI). Disc pinch, erosion of vertebral plateaus and vertebral collapse were the major signs. Once the diagnosis was retained for these patients, the first week noted a most significant clinical improvement (56.8%) in patients diagnosed with a range of suggestive arguments (p = 0.002). During the second week, clinical improvement was most marked in patients diagnosed with suggestive clinical and paraclinical arguments (70.3%) but with no statistically significant difference (p = 0.1). The improvement was statistically greater during the fourth week (66.7%) and the third month (60%) in patients diagnosed with histological examination (p &lt; 0.001). Figure 1. SPDT Diagnostic Strategy SPDT= Tuberculous spondylodiscitis, CBC= Cell blood count, NNA= Normochromic normocytic anemia, CRP= C reactive protein, SR= Sedimentation rate, BK= koch’s bacillus, SPDI= infectious spondylodiscitis, SPDNT= Non-tuberculous spondylodiscitis Conclusion Tuberculous spondylodiscitis is a frequent condition that needs to be treated rapidly. A range of highly suggestive clinical, paraclinical and evolutionary arguments contribute in the majority of cases to the positive diagnosis with a comparative clinical evolution to that of the DVBP which remains an invasive exam with variable sensitivity depending on studies. Disclosure of Interests None declared